Homestead_Wagner (3) H. PREPARER
Preparer of the Sales Disclosure Form Title
Kris Coon Closing Agent
Company
Address(number and street,city,state,country,and ZIP Code)
4600 Washington Ave., Suite 102, Evansville, IN 47714
I. SELLERS)/GRANTOR(S)
Seller 1 -Name as it appears on conveyance document Seller 2-Name as appea c ance document
Wendy Herrera
Address(number and street) Address(number and street)
1101 Beach Road 4
' 1)
City,state,and ZIP Code City,state,and ZIP Code '
West Palm Beach, FL 33404 �0 202f
Country Country G/e
USA sO,y
n Q
penalties of perjury,I hereby certify this Sales Disclosure,to the best of my knowledge and belief,444Ue,correct and complete as
required by law,and is prepared In accordance with IC 6-1.1-5.5.A person who knowingly and intentionally falsifies the value of transferred
rreal p ,perty,or omits or falsifies any information required to be provided,commits a Level 5 felony.
Signat e of Seller Signature of Seller
: inted Name of Seller Date signed(mm/dd/yyyy) Printed Name of Seller Date signed(mm/dd/yyyy)
Wendy Herrera
J. BUYER(S)/GRANTEE(S)—APPLICATION FOR PROPERTY TAX DEDUCTIONS-IDENTIFY ALL THAT APPLY
Buyer 1-Name as it appears on conveyance document Buyer 2-Name as it appears on conveyance document
ReShay Wagner
Address(number and street) Address(number and street)
211 S Gibson Street
City,state,and ZIP Code City,state,and ZIP Code
Princeton IN 47670
Country Country -
0,0
USA
( )
t.y Pursuant to IC 6-1.1-12-44,the Sales Disclosure Form may be used to apply for certain deductions.Identify all of those that apply:
OO YES NO CONDITION YEES/NO CONDITION
S " 1.Will this property be the buyer's primary 4Y 0 3. Homestead
w� O residence?
OO 1vJ 0 � 4. Solar Energy Heating or Cooling System
0 O 2. Does the buyer have a homestead to be vacated 0 '0, 5.Wind Power Device
i for this residence? If yes, provide address: 0 `3 6.Hydroelectric Power Device
,X Adis,,316mbeactd strt) c 0 " 7.Geothermal Energy Heating or Cooling Device
01.3c-4,y.,state,,ZII�car .a1 co�nry4-1 n G Z- '(° Ll l71 -C7C7°• 4 g O Z-y
1
Page 3 of 5
Page 3 of 5
copy